Auto insurance after a motor vehicle accident (HCAI)

Every Ontario auto-insurance policy includes accident benefits. These benefits pay for your physiotherapy, chiropractic, massage therapy, acupuncture, psychology and assessments after a motor vehicle accident — regardless of who caused the accident. We file the following forms through the HCAI system on your behalf:

• OCF-1 — Application for Accident Benefits. Initiates your claim with the insurer.
• OCF-3 — Disability Certificate. Documents impairments and supports your benefit tier.
• OCF-18 — Treatment and Assessment Plan. The plan that authorises your treatment package. We draft it within 24 hours of intake.
• OCF-21 — Auto Insurance Standard Invoice. Submitted automatically as your treatment proceeds.

You only ever pay an out-of-pocket amount if you exhaust your benefit limit, and we will tell you long before that happens.

WSIB — workplace injury

Prime Health Care is a registered WSIB healthcare provider. If you were injured at work, your WSIB claim covers physiotherapy, chiropractic, registered massage therapy and assessments under the WSIB fee schedule. We bill WSIB directly. You bring your WSIB claim number and a photo ID; we coordinate Form 7 and the Functional Abilities Form (FAF) and, with your consent, communicate with your employer’s return-to-work coordinator.

Extended-health benefits (employer or private plans)

We accept direct billing from most major insurers. If your plan is on this list, you usually pay nothing at the front desk; if there is a co-pay, we tell you upfront.

• Sun Life
• Manulife (including ManulifePlus)
• Canada Life (formerly Great-West Life)
• Green Shield Canada
• Desjardins Insurance
• Industrial Alliance / iA Financial Group
• Equitable Life of Canada
• Empire Life
• GroupHEALTH / GroupSource
• Johnston Group / Maximum Benefit
• Cowan Insurance Group
• ClaimSecure
• Beneva (Beneva / La Capitale / SSQ)
• Most other Canadian extended-health insurers — call us and ask

What if my insurer is not on the list?

We will give you itemised receipts in the format your plan needs, and we will submit on your behalf where electronic submission is supported. The vast majority of plans reimburse the same amount whether you pay first or we do.

Other coverage we coordinate

• Veterans Affairs Canada (VAC). We submit through the Medavie Blue Cross VAC portal for eligible veterans.
• Non-Insured Health Benefits (NIHB). For First Nations and Inuit clients, we submit through the NIHB provider portal.

Long-Term-Disability (LTD). We coordinate with LTD carriers and case managers and provide return-to-work assessments where requested.